Thrombophilia and collagen disease in ART

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Presentation transcript:

Thrombophilia and collagen disease in ART s.Salehpour Associate professor. SBMU Medical Director IVF Center. Taleghani Hospital. Autumn 2014-Tehran university

- Incidence of Thrombophilia: 1.6/100000 Major complication in IVF cycle: thromboembolism COH→ Protein C resistance→ DVT HCG injection → ↑ Factor II, V, vII, vIII, Ix ( Last 3 weeks after pregnancy)

Indication for thrombophilia screening beforeIVF: - recurrent miscarriage - RIF - hx of VTE - hx of OHSS - Serious infection - Immobilization

Management of thrombophilia during IVF:

SLE and APS: Fertility is normal in SLE and APS except in: - Amenorrhea - Renal insufficiency related subfertility - ovarian failure due to cyclophosphamide

COH→↑ estrogen thombosis exacerbation of disease

Safe COH: 1- SLE in Remission (6-12 months after last flare) 2- NO deep organ involvement 3- NO APS or low titer 4- Prophylactic anti coagulant 5- Prophylactic anti inflammatory 6- low dose Aspirin

Special considerations in ART for SLE and APS: - avoid OCP - Mild Stimulation - Prevent OHSS - SET

LPS in SLE and APS - Progesterone better than HCG - Vaginal progesterone better than oral (Hepatic first pass)

Pregnancy and SLE and APS - Flare of SLE - deterioration of Renal function - ↑ thrombosis - ↑ miscarriage - ↑ IUFD - ↑ PIH/preeclampsia - ↑ IUGR - ↑ PRETERM LABOR - ↑ congenital heart block

Discourage pregnancy in: - bad arterial hypertension - Pulmonary hypertension - Advanced Renal disease - Severe heart disease - previous thrombotic events.